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  • Ataxia can result from a variety of lesions, including damage to the peripheral nerves, spinal cord, cerebellum, and cerebral hemispheres. One of the most common etiologies is drug intoxication, especially with alcohol, benzodiazepines, or phenytoin.
  • Findings of cerebellar dysfunction include nystagmus, staggering, wide-based gait, and titubation. In addition, a sensory examination for light touch and pinprick, position, and vibration sense should be performed because lower extremity sensory impairment can cause ataxia.
  • In a patient with acute ataxia, the history and physical examination focus on excluding acute infectious etiologies, such as meningitis or encephalitis, lesions that result in increased intracranial pressure, such as hemorrhage and tumors, and toxic ingestions.
  • A common cause of ataxia in children younger than 5 years is acute cerebellar ataxia, a postinfectious phenomenon that often occurs about 2 weeks after a viral illness. The onset of ataxia is insidious and predominantly affects the gait, although dysmetria, nystagmus, and dysarthria can occur.
  • In children, the most common cause of intermittent ataxia is a migraine headache that involves the basilar artery. Besides ataxia, associated symptoms include blurred vision, visual field deficits, vertigo, and headache.
  • Chronic progressive ataxia has an insidious onset and progresses slowly over weeks to months. The differential diagnosis consists of brain tumors, hydrocephalus, and neurodegenerative disorders.
  • The combination of ataxia, headache, irritability, and vomiting in a child younger than 6 years is characteristic of a medulloblastoma.
  • Hereditary causes of ataxia include spinocerebellar ataxias, of which there are 28 types. Friedrich's ataxia is common autosomal recessive ataxia, which usually manifests before 10 years of age. It is characterized by ataxia, nystagmus, kyphoscoliosis, cardiomyopathy, and distal muscle wasting.
  • Patients with progressive ataxia require an aggressive evaluation in the emergency department. All patients are examined for signs of increased intracranial pressure, which in some cases can be severe enough to result in the threat of uncal herniation.
  • The emergency department evaluation of chronic nonprogressive ataxia consists of ensuring, by a careful history and physical examination, that the problem is indeed stable.

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Ataxia is a disorder of intentional movement, characterized by impaired balance and coordination. It can variably affect the trunk or extremities. Severe truncal ataxia is sometimes referred to as titubation. Ataxia of the extremities can result in a wide-based gait or can cause dysmetria, which is the tendency of the limbs to overshoot a target, with subsequent movements attempting to correct the overshoot.1,2

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Ataxia can be congenital/genetic or acquired. Acquired ataxia is often classified as acute, episodic/intermittent, or chronic.1

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Ataxia can result from a variety of lesions, including damage to the peripheral nerves, spinal cord, cerebellum, and cerebral hemispheres. Lesions of the cerebellum can be further categorized as affecting the hemispheres, which results in ipsilateral limb hypotonia, tremor, and dysmetria, but spare speech. With walking, these patients tend to veer to the side of the lesion. Lesions of the midline vermis cause truncal ataxia or titubation, dysarthria, and gait abnormalities.1 Damage ...

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